Psychosis (including schizophrenia) Flashcards
give some examples of psychotic symptoms 6
hallucinations
delusions
disorganised thought
catatonia
affective distrubance
avolition
how can schizophrenia first rank sympotms be classified 4
auditory hallucinations
thought disorders
passivitiy phenomena
delusional perceptions
what types of auditory hallucinations are seen in schizophrenia 3
two or more voices discussion the patient in the third person
though echo
voices commenting on the patients behaviour
types of thought disorder seen in schizophrenia 3
thought insertion
thought withdrawal
thought broadcasting
describe passivity phenomena seen in schizophrenia 2
bodily sensations being controlled by external influence
examples:
-actions/impulses/feelings- experiences which are imposed on the individual or influenced by others
describe delusionsal perceptiosn seen in schizophrenia
two stage process
-first normal object is perceived
-then secondly there is a sudden intense delusional insight into the objects meaning for the patient
eg that traffic light is green therefore i am the king
other features of schizophrenia 6
impaired insight
incongruiting/bluding of affect (inapporpriate emotion for circumstances)
decreased speech
neologisms: made up words
catatonia-awake but does not respond to people or environment
negative symptoms
-anhedonia (inability to derive pleasure)
-alogia (poverty of speech)
-avolition (poor motivation)
what factors are associated with a poor prognosis in schizophrenia 5
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitants
describe thoguht insertion
someone is putting ideas into the patients head
describe thought broadcasting
people overhear patients thoughts
describe thought withdrawal
thoughts are being taken out of my head
diagnotic criteria for schizophrenia 6
symptoms must last for ≥6 months
-at least 1 month of severe symptoms
-marked impairment in work or home function
must have very clear symptoms of 1 of the following or 2 or more if less clear cut:
-all the first rank symptoms:
-
auditory hallucinations
thought disorders
passivitiy phenomena
delusional perceptions
state the 5 schizophrenia subtypes
paranoid schizophenia
hebephrenic sschizophrenia
catatonic schizophrenia
undifferentiated schizophrenia
residual schizophrenia
define paranoid schizophrenia
delusions and hallucinations dominate
=most common
define hebephrenic schizophrenia
age of onset 15-25
poor prognosis
thought disorder and affective distrubance dominate
define catatonic schizophrenia
catatonia dominates
-stupor
-posturing
-waxy flexibitly
-negativism
define undifferenitated schizophrenia
no specific subtype
define residual schizophrenia
negative symptoms dominate
when can prodromal symptoms for schizophrenia start
up to 18moths before first episode of psychosis but sometimes just a few days
how are prodromal sympotms of schizophrenia charactereised
-examples of changes 4
gradual deterioration in functioning
-sometimes conceptualized as ‘altered life trajectory’
changes:
-transisent and/or lower intensity psychotic syx
-odd (out of character) thoughts, beliefs and behaviours
-concentration problems
-altered affect
-social withdrawal
-reduced interest in daily activities
define schizoaffective disorder
*-treatemetn
a vairant of schizophrenia and affective (mood) disorders
-patient exepreinves syx of mood disorder (mania or depression) and schizophrenia at the same time (within days) and of the same intensiitivty
*-manage both conditions
-antipsychotics
-mood stabilizers
defire schizotypal disorders
personality disorder
-may represent parital expression of schizophrenia
-usually treated without medication
define schizophreniform disorder
those disorders fail to meet threshold for schizophrenia (usually duration of psychosi) but have syx of schizophrenia and deitriotiation in function
treated with antipsychotics
who gets schizophrenia4
strong genetic compoenet
later onset in women
lower socioectomic
higher incidence in immigrants/minority ethic groups
biological risk factors for schizophrenia 4
familial geentic risk
structual brain cahges
intelecual impaired
substance use
psychiligcal risk factors for schizophrenia 2
probelm with learning. attention, planning
biases in emotional and reasoning processes
social risk factors for schizophrenia 3
urban birth and rearing
social adversity and trauma
migration and stressful life events all increase
dopamine abnormalites in schizophrenia 2
nigrostriatal pathways
-excessive dopamie transmission assoc w positive syx
mesocrotical & mesolimbic
-reduced dopamine transimson-> impaired cognition and possible negative syx
brain changes in schizophrenia
cortex, hippocampus/amygdal reduced
ventircles enlarged
decreased blood flow in areas involved in frontal lobe in tests of executive function
acute manaegmnt of schizophrenia 5
risk assessment
phsyucial health chekc
drug treatmetn
education
family education + support
psychosocial interventions
aspects of maintanence managemtn for schizophrenia 4
MDT approach
co-morbitidy checks
side effect monitoring
social/occupational recovery
describe the role of psychological interventiosn for schizophrenia 5
recommned in all managemtn plans
-prmote quick recovery and relapse prevention
-strong evidence for EARLY CBT
-general or targeted at auditory hallucinations
address acute syx first then residual syx
if concurrent substances missue - abstiennce improves overall prognosis
work with family
before starting an antipsychotic what needs to be checked
ask about personal and FHx of:
-DM
-HT
-CVD
give advice on weight, diet and excersies
perform:
-BP
-weight
-BM
-lipid profile FBC
what needs to be completed before a patient is started on clozoapine
ECH
what needs to be monitored when on an antipsychotic and how ofeter
6 monthly monitoring of:
-LFT
-U&Es
-Prolactin
-weight
-HbA1c
what is first line for schizophrenia (drug class)
second generation antipsychotics
examples of second generation antipsychotics 5
-why are they preferred
5HT2A and D2 antagnoists
amisulpride (D2)
olanzapine (D2)
quetiapine (D2)
repseridone (D2)
clozapine (5HT2A)
lower risk of extrapyramidal side effects compared to 1st generation APs but more metabolic side effects:
-weight gain
-hyperglycaemia
-dyslipidaemia
exaamples of 1st generation antipsychotics 2
-why are they second line for treatment of schizophrenia
D2 antagnoists
chlorpromazine
haloperidol
-can extrapyridmal side effects
-often the reason patients stop taking their tablets
an example of third generation antipsychots 1
dopamine partial agnoists
only licensed TGA is aripiprazole
when is clozapine used
-why can it be dangerous
used for treatment-resistnat schizophrenia
has associated decreased sucicde risk
-
agranulocytosis risk in first year
-needs specialist monitoring
state some examples of extrapyrmidal side effects and how to treat these 4
parkinsonism
-decrease dose
-change to 2nd gen AP
acute dystonia -uncontrolled muscle movements (can occur within hours of starting AP)
-give procyclidine IM/IV
-may take up to 30 minutes to work
akathisia (subjective sense of psychomotor restlessness)
-within hours to weeks of starting AP
-decrease dose or change to 2nd gen AP
may need propanolol ± cyproheptadine
tardive dyskinesia (chewing, grimaces, choreoathetoisis(episodes of unwanted, uncontrollable movements, often of the muscles in the arms, legs, face, and body.))
-can be irreversible
-try tetrabenzine
regarding antipsychotic side effects
-side effects of dopamine blockades 2
EPSEs
TD
regarding antipsychotic side effects
-side effects of alpha adrenergic blockage 2
dizziness
hypotension
regarding antipsychotic side effects
-side effects of histamine blockade 2
drowsieness
weight gain
regarding antipsychotic side effects
-side effects of muscarinic blockade 3
dry mouth
constipation
urine retention
common co morbitities to schizophrenia 6
alcohol/substance missure
social anxiety/ anxiety disordeers
trauma/PTSD
low confidence/self esteme
mood disorder
aspergers
whn are outcomes worse with schizoprhenia 4
men
substance misure
low IQ
long duration of untreated psychosis
lifestyle issues with antipsychotic use and how to combat 3
hunger after taking medication
-consider bedtime dose
increased thirst
-suggest water or sugar free alternative
smoking-
-induces metbalisisma dn thus reduces antispychoitc plasma level
-increase dose and review if they quit
include targeted health promotion
-diet
-physical exercise
-smoking cessation
common side effects of antipsychotic drugs 6
extrapyrmaidal side effects
hyperprolactinaemia
sexual dysfunction
weight gain
DM
CV effects
daytime drowsiness
another name for substance induced psychosis
toxic psychosis or drug induced psychosis
what is an important point regarding substance induced psychosis
25% of people with substance induced psychosis go onto be diagnosed with schizoprhenia
examples of substances that can cause substance induced psychosis 7
alcohol
opiods
cannabinoid
benzos
stimulants: amphetamines
cocaine
hallucinogens
volatile inhalants
what medications can cause substance induced psychosis 3
fluoroquinolone
dextromorpha
certainhigh dose antihistamines
management of substance induced psychosis 2
hospitlaisation for detoxification and
possible antipyshcoitcs/benzo for symptom control
define delusiounal disorder
firmly held false belief (delusions)
persist for at least 1 month
-without other syx of psychosis
how is delusional disorder distinguied from schizophrenia
precense of delusions without any other syx of psychosis
how are delusions distinguished from mistkaen belifed s
remain unchnaged in face of clear, resonable evidence to the contrary
define bizzare vs nonbizarre delusison
non-bizzare- invovle situations that could occur
eg being followed, infected
bizarre- implausible situations such as believing someone removed internal organs with no scar
who gets delusional disorder
relatively uncommon
-onset involutional
-middle or late adult life
patients may have a pre-exisitng paranoid personality disorder
-pervasive distrust & suspicion of others
-can begin in early adulthood
what is delusional disorder in older patients
sometimes called paraphrenia
-can coexist with mild dementia
give a brief overview of the subtypes of delusional disorder 5
erotomaitc-patinets beleive another person is in love with them
grandiose
-great talent or important discovery
jealous- spouse/lover is unfaithful
persecutory
-being plotted against, spied on or harassed
somatic - bodily function
-have physical deformity, odor, parasite
diagnosis of delusional disorder
clinical evaluation and assessement
rule out other specific conduction assoc w delusions
managemnt of delusional disorder
estabilish effective patient doctor relationship
manage complications
sometimes antipyschotics
define puerperal psychosis
a rare complication of post partum depression
risk factors for postpartum psychosis
Hx of bipolar, schizoaffective disorder
FHx or personal Hx of postpartum psychosis
first rpegnnacy
discontinnuation of psych meds for pregnancy
management of postpartum psychosis 3
medical emergency
-need inpatinet care and for baby
use of antipsychotics and mood stabilizers
ECT shows good evidence
